PROBATE COURT OF LAKE COUNTY, OHIO MARK J. BARTOLOTTA, JUDGE ESTATE OF _________________________________________________, DECEASED Case No. _________________ Docket ___________________ Page ________________ RECEIPTS AND DISBURSEMENTS [Attach to fiduciary's account] Page_____of_____pages Following is an itemized statement of receipts and disbursements by the fiduciary in the adminstration of his trust. Item Voucher Value or Amount Value or Amount __________________________________________$_________________$___________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 13.1-RECEIPTS AND DISBURSEMENTS American LegalNet, Inc. www.FormsWorkFlow.com Page_____of_____pages Item Voucher Value or Amount Value or Amount __________________________________________$_________________$___________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ _________________________________________ Fiduciary American LegalNet, Inc. www.FormsWorkFlow.com